Type 2 Diabetes Prevention in the “Real World”: One-year results of the GOAL Implementation Trial

Pilvikki Absetz; Raisa Valve; Brian Oldenburg; Heikki Heinonen; Aulikki Nissinen; Mikael Fogelholm; Vesa Ilvesmäki; Martti Talja; Antti Uutela

doi:10.2337/dc07-0171

Clinical Care/Education/Nutrition/Psychosocial Research

Type 2 Diabetes Prevention in the “Real World”

One-year results of the GOAL Implementation Trial

Pilvikki Absetz, PHD1,
Raisa Valve, PHD2,
Brian Oldenburg, PHD3,
Heikki Heinonen, PHD1,
Aulikki Nissinen, MD, PHD1,
Mikael Fogelholm, SCD4,
Vesa Ilvesmäki, MD, PHD5,
Martti Talja, MD, PHD5 and
Antti Uutela, PHD1

¹Department of Health Promotion and Chronic Disease Prevention, National Public Health Institute, Helsinki, Finland
²Palmenia Centre for Continuing Education, University of Helsinki, Lahti, Finland
³Department of Epidemiology, Monash University, Melbourne, Australia
⁴UKK Institute for Health Promotion, Tampere, Finland
⁵Päijät-Häme Central Hospital, Lahti, Finland

Address correspondence and reprint requests to Pilvikki Absetz, Senior Researcher, Health Promotion and Chronic Disease Prevention, National Public Health Institute, Mannerheimintie 166, FI-00300 Helsinki, Finland. E-mail: pilvikki.absetz{at}ktl.fi

Diabetes Care 2007 Oct; 30(10): 2465-2470. https://doi.org/10.2337/dc07-0171

One-year results of the GOAL Implementation Trial

Abstract

OBJECTIVE—“Real-world” implementation of lifestyle interventions is a challenge. The Good Ageing in Lahti Region (GOAL) Lifestyle Implementation Trial was designed for the primary health care setting, with lifestyle and risk reduction objectives derived from the major diabetes prevention efficacy trials. We report on the program's effectiveness as well as findings related to the program's reach, adoption, and implementation.

RESEARCH DESIGN AND METHODS—A total of 352 middle-aged participants with elevated type 2 diabetes risk were recruited from the health care centers in Päijät-Häme Province in Finland. The intervention included six group counseling sessions, delivered by trained public health nurses. Measurement was conducted at baseline and 12 months. Clinical risk factors were measured by study nurses, and lifestyle outcomes were analyzed from self-reports. Lifestyle outcomes were compared with the outcomes achieved in relevant efficacy trials, and within-subject changes were tested for risk reduction.

RESULTS—At baseline, mean BMI was >32 kg/m², and 25% of the participants had impaired glucose tolerance. At 12 months, 20% of participants achieved at least four of five key lifestyle outcomes, with these results being comparable with the reference trials. However, physical activity and weight loss goals were achieved significantly less frequently (65 vs. 86% and 12 vs. 43%, respectively). Several clinical risk factors decreased, more so among men than women.

CONCLUSIONS—This trial demonstrates that lifestyle counseling can be effective and is feasible in real-world settings for individuals with elevated risk of type 2 diabetes. To increase program impact, program exposure and treatment intensity need to be increased.

Footnotes

Published ahead of print at http://care.diabetesjournals.org on 22 June 2007. DOI: 10.2337/dc07-0171. Clinical trial reg. no NCT00398060, clinicaltrials.gov.

A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.
- Accepted June 19, 2007.
- Received January 29, 2007.
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